PHARMACOTHERAPEUTICS OF MOOD DISORDERS IN PATIENTS ATTENDING NEURO PSYCHIATRIC CLINIC, AHMADU BELLO UNIVERSITY TEACHING HOSPITAL (ABUTH) ZARIA-NIGERIA
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ABSTRACT
Mood disorders (primary major depressive disorder and bipolar affective disorder) constitute one of the world’s greatest public health problems and are associated with significant reductions in productivity, health and longevity. This study involved a retrospective analysis of data obtained from hospital records of patients using this facility for a one year period spanning January 1st 2006 to December 31st, 2006. The study population was 887 patients. This study was carried out to describe prevalence, management, and burden of mood disorders among patients who attended clinic at the neuro-psychiatry unit of Ahmadu Bello University Teaching Hospital, Shika. Average clinic attendance in year 2006 was 48.47. With respect to relative occurrence, mood disorders (26%) ranked lower than schizophrenia (39.8%) but higher than seizure disorders (12.9%) and anxiety disorders (8.2%). Majority of the patients were female (62.1%), married (57.2%), Hausa (59.3%) and of Muslim faith (77.2%). Most were below thirty (57.2%) and had been attending clinics for five years or less. The mean age of patients was 28.3 years at index episode of mood disorders. More than half of patients with mood disorders (50.7%) were unemployed and 25.5% of these patients had tertiary education. Depression was the most prevalent subtype of mood disorders (52.4%). Bipolar affective disorders (32.4%), hypomania (9.0%) and mania (4.1%) were other subtypes of mood disorders identified. Only 24.8% of patients had record showing family history of mental disorder. Nearly two-third (64.8%) of patients with mood disorders had co-morbid diagnosis. Non-psychiatric co-morbid disorders (37.2%) were more prevalent than psychiatric co-morbid which were present in 27.6% patients. Malaria (15.7%) was the most commonly-occurring non-psychiatric co-morbid disorder while schizophrenia (9.0%) was the most prevalent psychiatric co-morbid diagnosis. vii Signs and symptoms varied and they included insomnia (which were the most prevalent), irrational talkativeness, dysphoric mood, loss of appetite and anxious mood. Haematological investigations (19.8% of patients), serum/urea/electrolyte/creatinine (18.0%), WBC differential (14.8%) was the most frequently requested laboratory investigations. Management of mood disorders involved the use of pharmacotherapy only (35.2%) or a combination of psychotherapy and pharmacotherapy. Drugs employed included amitriptylline (used in 63.4% of patients), imipramine (12.4%) nitrazepam (45.5%), diazepam injection (35.2%) and bromazepam (4.8%). Antipsychotics used included trifluoperazine (in 52.4%), haloperidol injection (45.5%), and chlorpromazine tablets (37.9%) among others. Mood stabilizers used included carbamazepine (in 35.2%) and sodium valporate (in 7.6%). Other drugs used were benzhexol which had the highest usage (83.4%) among patients with mood disorders in this study. Non-pharmacological approaches to treatment included ECT in 46.8% of patients, insight counseling (23.4%) and psychotherapy (7.4%). Drug use was accompanied by side effects which included weakness (13.1% of patients,) headache (8.7%), excessive sleep (8.1%) insomnia (7.2%) and dizziness (1.9%) among others. Reduction in dosage (in 22.8% patients), use of other drugs to remedy adverse events (22.1%), discontinuation and use of alternative drugs (13.1%), and reduction in frequency of administration (6.2%) were methods employed in management of side effects. Annual drug cost far outweighed cost of laboratory investigations. An average cost of N15,772.27 per patient per annum was spent on drugs for psychiatric disorders while the mean cost of total drugs was N18,136.04 per year. This is considered high in relation to Nigeria’s per capital income of N4.46 as most of these patients (76.2%) were viii unemployed and were dependent on caregivers. There was no significant different in cost of drugs as regards type of mood disorders.
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